title: When the wind goes out of the sail - declining recovery expectations in the first weeks of back pain.
abstract: BACKGROUND
  Expectations for recovery are a known predictor for returning to work. Most studies seem to conclude that the higher the expectancy the better the outcome. However, the development of expectations over time is rarely researched and experimental studies show that realistic expectations rather than high expectancies are the most adaptive. This study aims to explore patterns of stability and change in expectations for recovery during the first weeks of a back-pain episode and how these patterns relate to other psychological variables and outcome.
  
  
  METHODS
  The study included 496 volunteer patients seeking treatment for work-related, acute back pain. The participants were measured with self-report scales of depression, fear of pain, life impact of pain, catastrophizing and expectations for recovery at two time points. A follow-up focusing on recovery and return to work was conducted 3 months later. A cluster analysis was conducted, categorizing the data on the trajectories of recovery expectations.
  
  
  RESULTS
  Cluster analysis revealed four clusters regarding the development of expectations for recovery during a 2-week period after pain onset. Three out of four clusters showed stability in their expectations as well as corresponding levels of proximal psychological factors. The fourth cluster showed increases in distress and a decrease in expectations for recovery. This cluster also has poor odds ratios for returning to work and recovery.
  
  
  CONCLUSIONS
  Decreases in expectancies for recovery seem as important as baseline values in terms of outcome, which has clinical and theoretical implications.
authors.affiliation: Center of Health and Medical Psychology (CHAMP), School of Law, Psychology, and Social Work, Örebro University, Sweden.
authors.forename: J K P
authors.initials: JK
authors.lastname: Carstens
authors.forename: W S
authors.initials: WS
authors.lastname: Shaw
authors.forename: K
authors.initials: K
authors.lastname: Boersma
authors.forename: S E
authors.initials: SE
authors.lastname: Reme
authors.forename: G
authors.initials: G
authors.lastname: Pransky
authors.forename: S J
authors.initials: SJ
authors.lastname: Linton
mesh_terms: D000328:Adult; D001416:Back Pain / Q000503:physiopathology* / Q000523:psychology; D058443:Catastrophization / Q000503:physiopathology* / Q000523:psychology; D004185:Disability Evaluation; D005239:Fear / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000503:physiopathology* / Q000523:psychology; D010147:Pain Measurement / Q000523:psychology; D020127:Recovery of Function / Q000502:physiology*; D057566:Self Report; D014937:Work